Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 03175 | Date 14/10/2019 |
| Token No | SM/18-19/6886 14/10/2019 | Serial | 002 |
| Patient Name | Miss SOMA KUMARI | Contact No | 9433640537 |
| Address | 10 PAL BAGAN | Age | 22 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||